Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients...Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients with spinal fractures admitted between May 2023 and May 2024.The patients were divided into a control group and an experimental group based on treatment differences,with 24 patients in each group.The control group underwent open internal fixation surgery,while the experimental group received percutaneous pedicle screw minimally invasive surgery.Clinical index improvements,cervical dysfunction index,Japanese Orthopaedic Association scores,and pain level improvements were compared between the two groups.Results:The intraoperative blood loss,incision length,operation time,and hospitalization duration in the experimental group were(88.63±18.85),(6.32±1.05),(73.42±4.05),and(12.58±2.56),respectively,compared to(279.95±17.32),(12.89±1.36),(89.93±4.79),and(22.41±2.87)in the control group.Significant differences were observed between the groups,with the experimental group showing superior improvements across all metrics(P<0.05).Conclusion:Percutaneous pedicle screw minimally invasive surgery shows more significant effects in treating spinal fractures,particularly in improving cervical and lumbar spine function,enhancing treatment efficacy and safety,reducing pain levels,and shortening recovery time.Clinical application and promotion are recommended.展开更多
Objective:To evaluate and analyze the actual efficacy of percutaneous vertebroplasty in the treatment of old unstable osteoporotic spinal fractures.Methods:From March 2023 to March 2024,46 patients with old unstable o...Objective:To evaluate and analyze the actual efficacy of percutaneous vertebroplasty in the treatment of old unstable osteoporotic spinal fractures.Methods:From March 2023 to March 2024,46 patients with old unstable osteoporotic spinal fractures in our hospital were included in this study.They were divided into the conventional group and the observation group based on treatment differences,with 23 patients in each group.The conventional group received conservative drug therapy,while the observation group underwent percutaneous vertebroplasty.The following indicators were compared and analyzed between the two groups:clinical treatment effect and improvement in physical function indicators.Results:The treatment efficiency of the observation group was 95.65%(22/23),while that of the conventional group was 69.57%(16/23).There was a significant difference between the groups,and the treatment effect of the observation group was significantly better(P<0.05).After treatment,the scores of physical status,daily living ability,functional independence,and life obstacles in the observation group were(89.33±4.08),(88.72±4.08),(90.41±2.89),(72.35±3.22),respectively,while those in the conventional group were(68.54±4.21),(67.42±4.11),(73.48±2.75),(72.35±3.22).There was a significant difference between the groups,and the improvement in physical function indicators in the observation group was more pronounced(P<0.05).Conclusion:For patients with old unstable osteoporotic spinal fractures,the basic value of percutaneous vertebroplasty is significant.It can not only improve clinical efficacy and safety but also promote the gradual recovery of patients'physical function indicators.It is recommended for clinical reference and practical application.展开更多
Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this ...Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.展开更多
BACKGROUND Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology.Preliminary research has indicated huma...BACKGROUND Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology.Preliminary research has indicated human immunodeficiency virus(HIV)/antiretroviral therapy(ART)as predisposing agents to osteopenia and osteoporosis related complications.We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India.Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications.CASE SUMMARY A 35-year-old HIV positive male presented with a stress fracture of left femoral neck.The patient was on ART and reported no comorbidities.He went on to be successfully managed surgically.However,during work-up osteopenia of the contralateral proximal femur was recognised using Singh’s Index.Six months post-op the patient presented with right-sided femoral-neck stress fracture.At this stage the patient was nonconcordant with ART and denied surgical fixation.CONCLUSION In the absence of co-morbidities,several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation.We recommend routine screening all HIV-infected patients for osteopenia,especially in younger individuals.In low resource settings and district hospitals,pelvis radiograph&Singh’s index can be used for screening.展开更多
Spinal cord injury results in the loss of sensory,motor,and autonomic functions,which almost always produces permanent physical disability.Thus,in the search for more effective treatments than those already applied fo...Spinal cord injury results in the loss of sensory,motor,and autonomic functions,which almost always produces permanent physical disability.Thus,in the search for more effective treatments than those already applied for years,which are not entirely efficient,researches have been able to demonstrate the potential of biological strategies using biomaterials to tissue manufacturing through bioengineering and stem cell therapy as a neuroregenerative approach,seeking to promote neuronal recovery after spinal cord injury.Each of these strategies has been developed and meticulously evaluated in several animal models with the aim of analyzing the potential of interventions for neuronal repair and,consequently,boosting functional recovery.Although the majority of experimental research has been conducted in rodents,there is increasing recognition of the importance,and need,of evaluating the safety and efficacy of these interventions in non-human primates before moving to clinical trials involving therapies potentially promising in humans.This article is a literature review from databases(PubMed,Science Direct,Elsevier,Scielo,Redalyc,Cochrane,and NCBI)from 10 years ago to date,using keywords(spinal cord injury,cell therapy,non-human primates,humans,and bioengineering in spinal cord injury).From 110 retrieved articles,after two selection rounds based on inclusion and exclusion criteria,21 articles were analyzed.Thus,this review arises from the need to recognize the experimental therapeutic advances applied in non-human primates and even humans,aimed at deepening these strategies and identifying the advantages and influence of the results on extrapolation for clinical applicability in humans.展开更多
Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patien...Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patients with IFF admitted to the hospital from December 2022 to December 2024 were selected and randomly divided into two groups using a random number table.The combined group received surgery and traditional Chinese medicine dialectical therapy in three phases,while the control group received surgery alone.The total effective rate,fracture healing time,hip function score,and lower extremity function score were compared between the two groups.Results:The total effective rate was higher in the combined group than in the control group(P<0.05).After treatment,the fracture healing time was shorter in the combined group than in the control group,and the hip function and lower extremity function scores were higher in the combined group than in the control group(P<0.05).Conclusion:Surgical combination with traditional Chinese medicine dialectical therapy in three phases can shorten the fracture healing time of IFF patients and restore their hip and lower extremity function,demonstrating significant efficacy.展开更多
BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At presen...BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.展开更多
Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,a...Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,and 38 patients with multiple osteoporotic spinal fractures were selected for study evaluation.All patients were treated with kyphoplasty.The clinical indicators of the two groups were compared and analyzed.Results:The total effective rate was 94.7%and the complication rate was 5.3%.The height of midline,anterior and posterior vertebral body,Cobb angle,VAS score,ODI score and ADL score of 38 patients before and after treatment were compared,which were significantly better than those before treatment(P<0.05).Conclusion:The clinical effect of kyphoplasty in the treatment of elderly patients with multiple osteoporosis is significant,which can be promoted in all levels of medical institutions.展开更多
Implantable light therapy devices,utilizing red and infrared light,have garnered significant interest for their potential to enhance tissue repair and regeneration,particularly in the context of spinal cord injuries(S...Implantable light therapy devices,utilizing red and infrared light,have garnered significant interest for their potential to enhance tissue repair and regeneration,particularly in the context of spinal cord injuries(SCI).These light wavelengths,known for their ability to penetrate the skin,initiate cellular processes that promote healing,reduce inflammation,and support regenerative mechanisms.Emerging research suggests that red and infrared light therapies can facilitate SCI recovery by stimulating neural regeneration,improving blood circulation,and mitigating oxidative stress.This review explores the underlying mechanisms by which implantable light therapy devices influence spinal cord recovery,emphasizing their noninvasive nature and potential advantages over conventional treatment strategies.The therapeutic effects of these light therapies offer a promising novel approach for addressing spinal cord damage and improving patient outcomes.Although further studies are necessary to establish optimal treatment protocols by advancing systems with artificial intelligence(AI)and evaluating longterm effects,the evidence suggests that light-based therapies could play a critical complementary role in SCI treatment and rehabilitation.The findings presented highlight the growing potential of these therapies in advancing SCI recovery and enhancing therapeutic efficacy.展开更多
BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enha...BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.展开更多
BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hi...BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.展开更多
Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospec...Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.展开更多
Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid im...Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.展开更多
Objective:To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures.Methods...Objective:To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures.Methods: A total of 72 patients with osteoporotic distal radial fractures who were treated in the hospital between September 2015 and January 2017 were collected and divided into control group (n=36) and observation group (n=36) according to the random number table method. Control group received routine external fixation, and observation group received mid-frequency pulse therapy combined with external fixation. The differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were not statistically significant between the two groups. After 1 month of treatment, serum BGP, TAC and SOD levels of both groups of patients were higher than those before treatment whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those before treatment, and serum BGP, TAC and SOD levels of observation group were higher than those of control group whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those of control group.Conclusion: Mid-frequency pulse therapy combined with external fixation can promote fracture healing and reduce postoperative inflammatory response and oxidative stress response in patients with osteoporotic distal radial fracture.展开更多
Objective:To explore the clinical effect of internal fixation and fusion with the paraspinal muscle gap approach in the treatment of spinal fracture patients.Methods:104 spinal fracture patients admitted to Central Ho...Objective:To explore the clinical effect of internal fixation and fusion with the paraspinal muscle gap approach in the treatment of spinal fracture patients.Methods:104 spinal fracture patients admitted to Central Hospital of TCM from October 2022 to April 2024 were selected as the study subjects and were randomly divided into the control group(n=52)and the observation group(n=52)according to the random number table method.The control group was treated with the conventional approach of internal fixation surgery,and the observation group was treated with the paraspinal muscular interspace approach of internal fixation fusion.The two groups’general data,surgical indexes,pain,lumbar spine function,and postoperative complications were observed.Results:The baseline data of the two groups of patients were not statistically significant(all P>0.05)while the intraoperative bleeding,the first postoperative time getting up from bed,and the length of hospital stay of the patients in the observation group were shorter than that of the control group(all P=0.000<0.001),and the duration of the operation was longer than that of the control group(t=2.644,P=0.010<0.05);at 3 months postoperatively,the VAS scores of the patients in the observation group were significantly lower than those in the control group(t=10.768,P=0.000<0.001),and the JOA score was higher than that of the control group(t=6.498,P=0.000<0.001);the total complication rate of patients in the observation group(3/5.77%)was significantly lower than that of the control group(12/23.08%)(χ^(2)=6.310,P=0.012<0.05).Conclusion:In the treatment of spinal fracture patients,compared with the conventional approach to internal fixation surgery,the paraspinal muscular gap approach to internal fixation and fusion treatment is less traumatic,postoperative lumbar spine function recovery is faster,and can reduce the incidence of postoperative complications.展开更多
Objective: to explore the application and observation of high-quality nursing after internal fixation of thoracolumbar multi-segment spinal fractures. Methods: one hundred and fourteen patients with thoracolumbar mult...Objective: to explore the application and observation of high-quality nursing after internal fixation of thoracolumbar multi-segment spinal fractures. Methods: one hundred and fourteen patients with thoracolumbar multi-segment spinal fractures treated in our hospital were selected as the research object. The time interval was {2019.6-2021.6}. The patients were divided into high-quality group and basic group by single and double number grouping method. The high-quality group was treated with high-quality nursing while the basic group was treated with routine nursing. The excellent fracture healing probability of the two groups was compared. The probability of complications was compared between the two groups. The scores of adverse psychological emotions were compared between the high-quality group and the basic group. Compare the nursing satisfaction between the high-quality group and the basic group. Results: the percentage of excellent and good rate in high-quality group was higher than that in basic group (P < 0.05). The probability of complications in high-quality group was lower than that in basic group (P < 0.05). The scores of bad psychological emotions in the high-quality group were lower than those in the basic group (P < 0.05). The nursing satisfaction of the high-quality group was higher than that of the basic group (P < 0.05). Conclusion: For patients with thoracolumbar multi-segment fractures, high-quality nursing after the fixation operation can adjust the patients bad mood and control the occurrence probability of complications, which is beneficial to the fracture healing of patients and is worthy of clinical application.展开更多
Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three m...Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.展开更多
The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices...The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.展开更多
During the past decade, significant advances have been made in refinements for regenerative therapies following human spinal cord injury （SCI）. Positive results have been achieved with different types of cells in va...During the past decade, significant advances have been made in refinements for regenerative therapies following human spinal cord injury （SCI）. Positive results have been achieved with different types of cells in various clinical studies of SCI. In this review, we summarize recently-completed clinical trials using cell- mediated regenerative therapies for human SCI, together with ongoing trials using neural stem cells. Specifically, clinical studies published in Chinese journals are included. These studies show that current transplantation therapies are relatively safe, and have provided varying degrees of neurological recovery. However, many obstacles exist, hindering the introduction of a specific clinical therapy, including complications and their causes, selection of the target population, and optimization of transplantation material. Despite these and other challenges, with the collaboration of research groups and strong support from various organizations, cell-mediated regenerative therapies will open new perspectives for SCI treatment.展开更多
Spinal cord injury(SCI)is a serious traumatic disease of the central nervous system,which can give rise to the loss of motor and sensory function.Due to its complex pathological mechanism,the treatment of this disease...Spinal cord injury(SCI)is a serious traumatic disease of the central nervous system,which can give rise to the loss of motor and sensory function.Due to its complex pathological mechanism,the treatment of this disease still faces a huge challenge.Hydrogels with good biocompatibility and biodegradability can well imitate the extracellular matrix in the microenvironment of spinal cord.Hydrogels have been regarded as promising SCI repair material in recent years and continuous studies have confirmed that hydrogel-based therapy can effectively eliminate inflammation and promote spinal cord repair and regeneration to improve SCI.In this review,hydrogel-based multimodal therapeutic strategies to repair SCI are provided,and a combination of hydrogel scaffolds and other therapeutic modalities are discussed,with particular emphasis on the repair mechanism of SCI.展开更多
文摘Objective:To observe and study the actual effects of percutaneous pedicle screw minimally invasive surgery in the treatment of spinal fractures and its impact on spinal function.Methods:This study included 48 patients with spinal fractures admitted between May 2023 and May 2024.The patients were divided into a control group and an experimental group based on treatment differences,with 24 patients in each group.The control group underwent open internal fixation surgery,while the experimental group received percutaneous pedicle screw minimally invasive surgery.Clinical index improvements,cervical dysfunction index,Japanese Orthopaedic Association scores,and pain level improvements were compared between the two groups.Results:The intraoperative blood loss,incision length,operation time,and hospitalization duration in the experimental group were(88.63±18.85),(6.32±1.05),(73.42±4.05),and(12.58±2.56),respectively,compared to(279.95±17.32),(12.89±1.36),(89.93±4.79),and(22.41±2.87)in the control group.Significant differences were observed between the groups,with the experimental group showing superior improvements across all metrics(P<0.05).Conclusion:Percutaneous pedicle screw minimally invasive surgery shows more significant effects in treating spinal fractures,particularly in improving cervical and lumbar spine function,enhancing treatment efficacy and safety,reducing pain levels,and shortening recovery time.Clinical application and promotion are recommended.
文摘Objective:To evaluate and analyze the actual efficacy of percutaneous vertebroplasty in the treatment of old unstable osteoporotic spinal fractures.Methods:From March 2023 to March 2024,46 patients with old unstable osteoporotic spinal fractures in our hospital were included in this study.They were divided into the conventional group and the observation group based on treatment differences,with 23 patients in each group.The conventional group received conservative drug therapy,while the observation group underwent percutaneous vertebroplasty.The following indicators were compared and analyzed between the two groups:clinical treatment effect and improvement in physical function indicators.Results:The treatment efficiency of the observation group was 95.65%(22/23),while that of the conventional group was 69.57%(16/23).There was a significant difference between the groups,and the treatment effect of the observation group was significantly better(P<0.05).After treatment,the scores of physical status,daily living ability,functional independence,and life obstacles in the observation group were(89.33±4.08),(88.72±4.08),(90.41±2.89),(72.35±3.22),respectively,while those in the conventional group were(68.54±4.21),(67.42±4.11),(73.48±2.75),(72.35±3.22).There was a significant difference between the groups,and the improvement in physical function indicators in the observation group was more pronounced(P<0.05).Conclusion:For patients with old unstable osteoporotic spinal fractures,the basic value of percutaneous vertebroplasty is significant.It can not only improve clinical efficacy and safety but also promote the gradual recovery of patients'physical function indicators.It is recommended for clinical reference and practical application.
基金financially supported by the National Natural Science Foundation of China(Grant No.81672152 and No.81871773)the Jiangsu Natural Science Foundation(Grant No.BE2018132)。
文摘Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.
文摘BACKGROUND Femoral neck stress fractures are rarely encountered among young adults and are often associated with either repetitive excessive loading or underlying bone pathology.Preliminary research has indicated human immunodeficiency virus(HIV)/antiretroviral therapy(ART)as predisposing agents to osteopenia and osteoporosis related complications.We report a case of HIV/ART induced insufficiency fracture in a resource limited setting in Central India.Our aim is to increase awareness and promote screening of HIV/ART related osteopenia and osteoporosis in order to prevent catastrophic orthopaedic complications.CASE SUMMARY A 35-year-old HIV positive male presented with a stress fracture of left femoral neck.The patient was on ART and reported no comorbidities.He went on to be successfully managed surgically.However,during work-up osteopenia of the contralateral proximal femur was recognised using Singh’s Index.Six months post-op the patient presented with right-sided femoral-neck stress fracture.At this stage the patient was nonconcordant with ART and denied surgical fixation.CONCLUSION In the absence of co-morbidities,several mechanisms of HIV/antiretroviral therapy may have played a role in predisposing our patient towards such a presentation.We recommend routine screening all HIV-infected patients for osteopenia,especially in younger individuals.In low resource settings and district hospitals,pelvis radiograph&Singh’s index can be used for screening.
文摘Spinal cord injury results in the loss of sensory,motor,and autonomic functions,which almost always produces permanent physical disability.Thus,in the search for more effective treatments than those already applied for years,which are not entirely efficient,researches have been able to demonstrate the potential of biological strategies using biomaterials to tissue manufacturing through bioengineering and stem cell therapy as a neuroregenerative approach,seeking to promote neuronal recovery after spinal cord injury.Each of these strategies has been developed and meticulously evaluated in several animal models with the aim of analyzing the potential of interventions for neuronal repair and,consequently,boosting functional recovery.Although the majority of experimental research has been conducted in rodents,there is increasing recognition of the importance,and need,of evaluating the safety and efficacy of these interventions in non-human primates before moving to clinical trials involving therapies potentially promising in humans.This article is a literature review from databases(PubMed,Science Direct,Elsevier,Scielo,Redalyc,Cochrane,and NCBI)from 10 years ago to date,using keywords(spinal cord injury,cell therapy,non-human primates,humans,and bioengineering in spinal cord injury).From 110 retrieved articles,after two selection rounds based on inclusion and exclusion criteria,21 articles were analyzed.Thus,this review arises from the need to recognize the experimental therapeutic advances applied in non-human primates and even humans,aimed at deepening these strategies and identifying the advantages and influence of the results on extrapolation for clinical applicability in humans.
文摘Objective:To evaluate the effectiveness of surgical combination with traditional Chinese medicine dialectical therapy in three phases for the treatment of intertrochanteric fracture of the femur(IFF).Methods:84 patients with IFF admitted to the hospital from December 2022 to December 2024 were selected and randomly divided into two groups using a random number table.The combined group received surgery and traditional Chinese medicine dialectical therapy in three phases,while the control group received surgery alone.The total effective rate,fracture healing time,hip function score,and lower extremity function score were compared between the two groups.Results:The total effective rate was higher in the combined group than in the control group(P<0.05).After treatment,the fracture healing time was shorter in the combined group than in the control group,and the hip function and lower extremity function scores were higher in the combined group than in the control group(P<0.05).Conclusion:Surgical combination with traditional Chinese medicine dialectical therapy in three phases can shorten the fracture healing time of IFF patients and restore their hip and lower extremity function,demonstrating significant efficacy.
文摘BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.
文摘Objective:To evaluate the clinical effect of kyphoplasty in the treatment of multiple osteoporotic vertebral fractures in the elderly.Methods:The duration of the study was selected from January 2018 to December 2020,and 38 patients with multiple osteoporotic spinal fractures were selected for study evaluation.All patients were treated with kyphoplasty.The clinical indicators of the two groups were compared and analyzed.Results:The total effective rate was 94.7%and the complication rate was 5.3%.The height of midline,anterior and posterior vertebral body,Cobb angle,VAS score,ODI score and ADL score of 38 patients before and after treatment were compared,which were significantly better than those before treatment(P<0.05).Conclusion:The clinical effect of kyphoplasty in the treatment of elderly patients with multiple osteoporosis is significant,which can be promoted in all levels of medical institutions.
文摘Implantable light therapy devices,utilizing red and infrared light,have garnered significant interest for their potential to enhance tissue repair and regeneration,particularly in the context of spinal cord injuries(SCI).These light wavelengths,known for their ability to penetrate the skin,initiate cellular processes that promote healing,reduce inflammation,and support regenerative mechanisms.Emerging research suggests that red and infrared light therapies can facilitate SCI recovery by stimulating neural regeneration,improving blood circulation,and mitigating oxidative stress.This review explores the underlying mechanisms by which implantable light therapy devices influence spinal cord recovery,emphasizing their noninvasive nature and potential advantages over conventional treatment strategies.The therapeutic effects of these light therapies offer a promising novel approach for addressing spinal cord damage and improving patient outcomes.Although further studies are necessary to establish optimal treatment protocols by advancing systems with artificial intelligence(AI)and evaluating longterm effects,the evidence suggests that light-based therapies could play a critical complementary role in SCI treatment and rehabilitation.The findings presented highlight the growing potential of these therapies in advancing SCI recovery and enhancing therapeutic efficacy.
基金Supported by National Natural Science Foundation of China,No.82172441Suzhou City Major Disease Multicenter Clinical Research Project,No.DZXYJ202312+2 种基金Special Funding for Jiangsu Province Science and Technology Plan(Key Research and Development Program for Social Development),No.BE2023737Gusu Health Talent Plan Scientific Research Project,No.GSWS2022109Postgraduate Research and Practice Innovation Program of Jiangsu Province,No.SJCX24_2446.
文摘BACKGROUND Fracture nonunion represents a challenging complication during fracture repair,often necessitating surgical intervention.Teriparatide,a recombinant human parathyroid hormone,has demonstrated promise in enhancing fracture healing,although its efficacy in treating established nonunion remains under investigation.CASE SUMMARY We report a case of a 27-year-old male who presented with a right humerus fracture following a traffic accident.Despite undergoing open reduction and internal fixation,the fracture resulted in a delayed union and subsequent nonunion.After 4 years of conservative management,teriparatide treatment was initiated due to persistent nonunion.Teriparatide injections were administered daily for 6 months,resulting in complete fracture healing and resolution of pain.CONCLUSION Our case demonstrates the successful use of teriparatide in treating a prolonged nonunion of a humerus fracture.Teriparatide may provide a valuable therapeutic option for established bone nonunion,even in cases that have not responded to conservative treatments.
文摘BACKGROUND Acromegaly,a disease of excess growth hormone,is known to alter bone structure and increase the risk of osteoporosis and fractures.This study aimed to assess the prevalence of vertebral,non-vertebral,and hip fragility fractures,as well as osteoporosis,in a cohort of patients with acromegaly.AIM To assess the prevalence of vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis in patients diagnosed with acromegaly.METHODS Data were collected on age,sex,body mass index(BMI),time from diagnosis of acromegaly,insulin-like growth factor(IGF-1)levels,disease control,pharmacological management,risk factors for osteoporosis,vertebral fragility fractures,non-vertebral fragility fractures,hip fragility fractures,and osteoporosis.RESULTS A total of 124 patients with acromegaly were included(67 men and 57 women).The mean age at diagnosis was 44±12 years;the mean time from diagnosis was 12±8 years;and the mean BMI was 27±4 kg/m².Fragility fractures were found in 27 patients(21%).There were no significant differences in the presence of osteoporosis or fragility fractures according to age,sex,BMI,duration of acrom egaly,or IGF-1 levels at diagnosis.A higher percentage of patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis(46%vs 15%;P<0.05).CONCLUSION A high prevalence of osteoporosis and fragility fractures was found in patients with acromegaly,regardless of age,sex,BMI,time from diagnosis,IGF-1 levels,and disease control.More patients with osteoporosis were treated with somatostatin analogs compared to those without osteoporosis.Taken together,our results suggest that the severity of the disease and the need for second-line therapies,may be associated with the increased risk of osteoporosis.
文摘Objective:To investigate the relationship between morphological abnormalities and spinal cord deficit in thoracolumbar burst fractures. Methods: Seventy-eight patients with thoracolumbar burst fractures were retrospectively reviewed to calculate the stenotic ratio of spinal canal based on the midsagittal diameters and the hyphosis angle according to Cobb. The ASIA scoring of motor function of lower extremities was recorded . Results: The differences (P > 0.05) of the stenotic ratio of spinal canal and the kyphosis angle were not significant between patients without neurological deficit, with incomplete and complete lesions. No significant correlation(P > 0.05) between the stenotic ratio of spinal canal and the kyphosis angle, and ASIA scoring was noted. Conclusion:The severity of spinal cord injuries in thoracolumbar burst fractures is not predicted according to the percentage of canal stenosis or the degree of kyphesis induced by thoracolumbar burst fractures.
文摘Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.
文摘Objective:To study the effect of mid-frequency pulse therapy combined with external fixation on bone metabolism, inflammatory response and oxidative stress in patients with osteoporotic distal radial fractures.Methods: A total of 72 patients with osteoporotic distal radial fractures who were treated in the hospital between September 2015 and January 2017 were collected and divided into control group (n=36) and observation group (n=36) according to the random number table method. Control group received routine external fixation, and observation group received mid-frequency pulse therapy combined with external fixation. The differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of bone metabolism indexes, inflammatory factors and oxidative stress indexes were not statistically significant between the two groups. After 1 month of treatment, serum BGP, TAC and SOD levels of both groups of patients were higher than those before treatment whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those before treatment, and serum BGP, TAC and SOD levels of observation group were higher than those of control group whileβ-CTX, AKP, TRAP, CRP, IL-1β, IL-6 and MDA levels were lower than those of control group.Conclusion: Mid-frequency pulse therapy combined with external fixation can promote fracture healing and reduce postoperative inflammatory response and oxidative stress response in patients with osteoporotic distal radial fracture.
基金Hebei Province’s 2020 Medical Scientific Research Topics“Clinical Study on Simultaneous Treatment of Multi-Segment Lumbar Disc Herniation with Transforaminal Endoscopy”(Project No.:1951ZF073)。
文摘Objective:To explore the clinical effect of internal fixation and fusion with the paraspinal muscle gap approach in the treatment of spinal fracture patients.Methods:104 spinal fracture patients admitted to Central Hospital of TCM from October 2022 to April 2024 were selected as the study subjects and were randomly divided into the control group(n=52)and the observation group(n=52)according to the random number table method.The control group was treated with the conventional approach of internal fixation surgery,and the observation group was treated with the paraspinal muscular interspace approach of internal fixation fusion.The two groups’general data,surgical indexes,pain,lumbar spine function,and postoperative complications were observed.Results:The baseline data of the two groups of patients were not statistically significant(all P>0.05)while the intraoperative bleeding,the first postoperative time getting up from bed,and the length of hospital stay of the patients in the observation group were shorter than that of the control group(all P=0.000<0.001),and the duration of the operation was longer than that of the control group(t=2.644,P=0.010<0.05);at 3 months postoperatively,the VAS scores of the patients in the observation group were significantly lower than those in the control group(t=10.768,P=0.000<0.001),and the JOA score was higher than that of the control group(t=6.498,P=0.000<0.001);the total complication rate of patients in the observation group(3/5.77%)was significantly lower than that of the control group(12/23.08%)(χ^(2)=6.310,P=0.012<0.05).Conclusion:In the treatment of spinal fracture patients,compared with the conventional approach to internal fixation surgery,the paraspinal muscular gap approach to internal fixation and fusion treatment is less traumatic,postoperative lumbar spine function recovery is faster,and can reduce the incidence of postoperative complications.
文摘Objective: to explore the application and observation of high-quality nursing after internal fixation of thoracolumbar multi-segment spinal fractures. Methods: one hundred and fourteen patients with thoracolumbar multi-segment spinal fractures treated in our hospital were selected as the research object. The time interval was {2019.6-2021.6}. The patients were divided into high-quality group and basic group by single and double number grouping method. The high-quality group was treated with high-quality nursing while the basic group was treated with routine nursing. The excellent fracture healing probability of the two groups was compared. The probability of complications was compared between the two groups. The scores of adverse psychological emotions were compared between the high-quality group and the basic group. Compare the nursing satisfaction between the high-quality group and the basic group. Results: the percentage of excellent and good rate in high-quality group was higher than that in basic group (P < 0.05). The probability of complications in high-quality group was lower than that in basic group (P < 0.05). The scores of bad psychological emotions in the high-quality group were lower than those in the basic group (P < 0.05). The nursing satisfaction of the high-quality group was higher than that of the basic group (P < 0.05). Conclusion: For patients with thoracolumbar multi-segment fractures, high-quality nursing after the fixation operation can adjust the patients bad mood and control the occurrence probability of complications, which is beneficial to the fracture healing of patients and is worthy of clinical application.
基金supported by the National Natural Science Foundation of China,No.81060182the Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2012211B34the Key Technology Research and Development and Major Program of Xinjiang Uygur Autonomous Region,No.200833116
文摘Tumor models were simulated in purebred Beagles at the T9-10 levels of the spinal cord and treated with spinal image-guided radiation therapy or conventional radiation therapy with 50 or 70 Gy total radiation. Three months after radiation, neuronal injury at the T9-10 levels was observed, including reversible injury induced by spinal image-guided radiation therapy and apoptosis induced by conventional radiation therapy. The number of apoptotic cells and expression of the proapoptotic protein Fas were significantly reduced, but expression of the anti-apoptotic protein heat shock protein 70 was significantly increased after image-guided radiation therapy compared with the conventional method of the same radiation dose. Moreover, the spinal cord cell apoptotic index positively correlated with the ratio of Fas/heat shock protein 70. These findings indicate that 3 months of radiation therapy can induce a late response in the spinal cord to radiation therapy; image-guided radiation therapy is safer and results in less neuronal injury compared with conventional radiation therapy.
基金the National Natural Science Foundation of China for Youths, No.30901483the Natural Science Foundation of Shanxi Province for Youths,No. 2009021041-3Projects of Patent Promoteand Implementation of Shanxi Province, No.111009
文摘The duplication of animal models plays a key role in spinal cord injury research; however, there has been limited study into normal, external force-derived fracture dislocation. This study adopted experimental devices, designed in-house, to construct standardized ventral and dorsal spinal cord injury animal models of 6 g and 17 g falling from a height of 2, 4, and 10 cm, and 15, 30 or 50 g transversal compression on the spinal cord. The results showed that gradual increases in the degree of histopathological injury led to decreased Tarlov and Basso, Beattie and Bresnahan scores for the behavioral test, and increased Ashworth scores for the hind limb. Furthermore, there was a gradual decline in the slope test in the rats with dorsal spinal cord injury that correlated to increases in the falling substance weight or falling height. Similar alterations were observed in the ventral spinal cord injured rats, proportional to the increase in compression weight. Our experimental findings indicate that the standardized experimental rat models of dorsal and ventral spinal cord injury are stable, reliable and reproducible.
基金supported by grants from the National Natural Science Foundation of China (81271003)he National Basic Research Development Program (973 Program) of China (2010CB945500,2012CB966300,2009CB941100)
文摘During the past decade, significant advances have been made in refinements for regenerative therapies following human spinal cord injury （SCI）. Positive results have been achieved with different types of cells in various clinical studies of SCI. In this review, we summarize recently-completed clinical trials using cell- mediated regenerative therapies for human SCI, together with ongoing trials using neural stem cells. Specifically, clinical studies published in Chinese journals are included. These studies show that current transplantation therapies are relatively safe, and have provided varying degrees of neurological recovery. However, many obstacles exist, hindering the introduction of a specific clinical therapy, including complications and their causes, selection of the target population, and optimization of transplantation material. Despite these and other challenges, with the collaboration of research groups and strong support from various organizations, cell-mediated regenerative therapies will open new perspectives for SCI treatment.
文摘Spinal cord injury(SCI)is a serious traumatic disease of the central nervous system,which can give rise to the loss of motor and sensory function.Due to its complex pathological mechanism,the treatment of this disease still faces a huge challenge.Hydrogels with good biocompatibility and biodegradability can well imitate the extracellular matrix in the microenvironment of spinal cord.Hydrogels have been regarded as promising SCI repair material in recent years and continuous studies have confirmed that hydrogel-based therapy can effectively eliminate inflammation and promote spinal cord repair and regeneration to improve SCI.In this review,hydrogel-based multimodal therapeutic strategies to repair SCI are provided,and a combination of hydrogel scaffolds and other therapeutic modalities are discussed,with particular emphasis on the repair mechanism of SCI.
